Açıklanamayan İnfertiliteye Güncel Bakış

  • Mehmet Fırat Mutlu
  • Ercan Baştu
  • Mesut Öktem
Keywords: Açıklanamayan infertilite, klomifen sitrat, gonadotropin, IVF

Abstract

Açıklanamayan infertilite, kovansiyonel tetkiklerle sebebi tespit edilemeyen ve infertil çiftlerin %15’inde görülen bir durumdur. Nedeni tespit edilemediği için tedavisinde kullanılan yöntemler nedeni ortadan kaldırmaktan çok ampirik olarak fertilite oranlarını artırmaya yöneliktir. Bu amaçla; bekleme tedavisi, klomifen sitrat, gonadotropin ile ovaryen hiperstimulasyon, intrasevikal inseminasyon, intrauterine inseminasyon ve in vitro fertilizasyon gibi tedavi yöntemleri günümüze kadar tek başlarına veya kombine olarak kullanılmaktadır. Bu derlemedeki amaç, literatürde mevcut tedavi yöntemlerinin etkinliğini göstererek, açıklamayan infertilite tedavisinde uygun tedavi stratejileri geliştirmeye yardımcı olmaktır.

References

Speroff L, Fritz MA, editors Female Infertility Clinical gynecologic endocrinoloy and infertility Lippincott Williams & Wilkins 2011. p.1185-1189

Fatum M, Laufer N, Simon A. Investigation of the infertile couple: should diag- nostic laparoscopy be performed after normal hysterosalpingography in treating infertility suspected to be of unknown origin? Hum Reprod 2002;17:1–3.

Reindollar RH, Regan MM, Neumann PJ, Levine BS, Thornton KL, Alper MM, Goldman MB. A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial. Fertil Steril 2010;94:888–99.

Guzick DS, Sullivan MW, Adamson GD, Cedars MI, Falk RJ, Peterson EP, Steinkampf MP. Efficacy of treatment for unexplained infertility. Fertil Steril 1998;70: 207–13.

Guzick DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP, et al. Efficacy of superovulation and in- trauterine insemination in the treatment of infertility. National Cooperative Reproductive Medicine Network. N Engl J Med 1999;340:177–83.

Tollner TL, Venners SA, Hollox EJ, Yudin AI, Liu X, Tang G, et al. A common mutation in the Defensin DEFB126 causes impaired sperm function and subfertility. Sci Transl Med 2011;3:92ra65.

Eijkemans MJ, Lintsen AM, Hunault CC, Bouwmans CA, Hakkaart L, Braat DD, et al. Pregnancy chances on an IVF/ ICSI waiting list: a national prospective cohort study. Hum Reprod 2008;23: 1627–32.

Hughes E, Brown J, Collins JJ, Vanderkerchove P. Clomiphene citrate for unexplained sub- fertility in women. Cochrane Database Syst Rev. 2010;20:CD000057.

Wordsworth S, Buchanan J, Mollison J, Harrild K, Robertson L, Tay C, et al. Clomifene citrate and intrauterine insemination as first-line treatments for unexplained infertility: are they cost-effective? Hum Reprod 2011;26:369–75.

Deaton JL, Gibson M, Blackmer KM, Nakajima ST, Badger GJ, Brumsted JR. A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis. Fertil Steril 1990;54:1083–8.

Huang KE. The primary treatment of luteal phase inadequacy: progesterone versus clomiphene citrate, Am J Obstet Gynecol 1986;155:824.

Reindollar RH, Regan MM, Neumann PJ, Levine BS, Thornton KL, Alper MM, et al. A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial. Fertil Steril 2010;94:888-99.

Badawy A, Shokeir T, Allam AF, Abdelhady H. Pregnancy outcome after ovulation induction with aromatase inhibitors or clomiphene citrate in unexplained infertility. Acta Obstet Gynecol Scand 2009;88:187–91.

Verhulst SM, Cohlen BJ, Hughes E, Te Velde E, Heineman MJ. Intra-uterine insemination for unexplained subfertility. Cochrane Database Syst Rev 2006;18 :4CD001838.

Practice Committee of the American Society for Reproductive Medicine. Effectiveness and treatment for unexplained infertility. Fertil Steril 2006;86 111–4.